Benefits for COVID-19 Vaccines
The COVID-19 vaccination is a Prescribed Minimum Benefit (PMB) and is covered fully by the Scheme from Scheme risk. The cost to administer the vaccine is also covered fully from Scheme risk. You should not be required to make any payments at the point of receiving the vaccine.
Only vaccinations administered within South Africa will be funded.
Benefits for PCR testing
- Beneficiaries are entitled to one (1) PCR test per annum
- To qualify for this benefit out-of-hospital, members must have consulted a GP
- Consultation with a GP is not required for pre-admission testing
- Members on the ProActive, ProActive Savvy, ProActive Plus and ProActive Plus Savvy options do not have access to day-to-day benefits or have limited day-to-day benefits:
- Claims submitted to the Scheme will be automatically rejected for benefits not available
- For claims to be considered for payment, please submit your test result and proof of consultation with a GP to email@example.com.
- Pathology for all positive PCR and antigen test results will be covered, including positive antigen test results for pre-admission
- Pathology for negative PCR tests will only be covered on submission of proof of consultation with a GP. Negative antigen tests will not be covered
- If you choose to be tested after exposure to someone with COVID-19, this will not be covered if the result is negative
- If you are not experiencing symptoms, it is not necessary to be tested. This is considered routine testing and will not be covered unless the test result is positive.
Supporting you through COVID
If you are struggling with Long COVID or the loss of a loved one as a result of COVID, please make use of our Trauma Assistance programme by calling 0861 776 363 and following the prompts. Appropriately trained consultants are available 24/7 to support you.
If you require oxygen at home, please call 0860 776 363 to access benefits and for home oxygen to be arranged for you.